About the Issue

In Canada, rates of HIV and hepatitis C virus (HCV) infection among prisoners are at least 10 and 30 times higher, respectively, than in the overall population. One of the main reasons for this is the sharing of used needles to inject drugs. Because of the scarcity of sterile injection equipment in prison, people who inject drugs behind bars are more likely to share and re-use injection equipment than people in the community. This significantly increases their risk of contracting HIV and HCV.

Prison needle and syringe programs (PNSPs) provide prisoners access to sterile injecting equipment and are an important way to reduce the risk of infection from sharing used needles. Yet in spite of the overwhelming evidence of the benefits of PNSPs around the world, no Canadian prison currently permits the distribution of sterile injection equipment to prisoners. Prisoners’ health has suffered as a result — a reality that is costly to public health and to the public purse when one considers the lifetime costs of treating HIV and HCV.

In 2006, the Public Health Agency of Canada (PHAC) conducted a study on the benefits of PNSPs and affirmed many of the positive findings of PNSP evaluations in many countries. Specifically, the PHAC report confirmed that PNSPs consistently :

reduce needle-sharing;

do not lead to increased drug use or injecting;

reduce drug overdoses;

facilitate getting users into drug treatment programmes;

have not resulted in needles or syringes being used as weapons against staff or other people in prison;

have been effective in a wide range of institutions; and

have effectively used different methods of needle distribution, including peer-to-peer distribution, hand-to-hand distribution by prison health care staff or outside agencies, and automatic dispensing machines.

Mistakenly, PNSPs are sometimes seen as controversial because people wrongly believe they enable drug use. There is also a common misconception that prisoners will use injection equipment as weapons against staff and each other. But in the over 60 prisons around the world where PNSPs exist, these fears have never been realized. Instead, PNSPs have prevented prisoners from taking part in risky behaviours that lead to HIV and HCV infection and may have a positive impact on prison security, because there are fewer used, hidden needles and people are less likely to be accidentally pricked with a used needle.

The failure to provide access to this essential disease preventing measure is a violation of prisoners' constitutional rights, and their right to health as established by international law. But because prisoners are a forgotten community, perceived to deserve whatever illnesses they get —especially if it is through drug use — the current Government of Canada will not implement PNSPs.

But the urgency for PNSPs has never been more pressing. With new legislation already contributing to overcrowding, violence and the number of people using drugs in prison, we all need to be aware of the health risks associated with inadequate harm reduction measures in prison and how it affects all Canadians — especially when most prisoners ultimately return to their communities.

“Syringes were smuggled into the institution. We shared syringes. The first time I injected drugs I shared a syringe. One syringe would probably be used for 3 or 4 months everyday for at least 20 times a day. We would sharpen it on a matchbook cover to keep it sharp.”

The Canadian HIV/AIDS Legal Network (www.aidslaw.ca) promotes the human rights of people living with and vulnerable to HIV/AIDS, in Canada and internationally, through research and analysis, advocacy and litigation, public education and community mobilization. The Legal Network is Canada's leading advocacy organization working on the legal and human rights issues raised by HIV/AIDS.